Patient Forms

To streamline your visit, please print and fill out the following forms and bring them to your first appointment.

PLEASE CLICK ON BUTTONS TO DOWNLOAD FORMS!

All New Patient Forms

Patient Registration Form
Medical Home Agreement
Consent Form
HIPPA Authorization
Sliding Fee Application
Notice of Privacy Policies

Adult Specific Forms

List of Prior Physicians

Pediatric Specific Forms

Permission to Authorize Care

Diabetes Forms

Diabetes Form
Diabetes Appointment Reminder

Nutrition Forms

Nutrition Questionnaire
Nutrition Appointment Reminder

Se Habla Español

“This health center is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).”
LCHC is an FTCA (Federal Tort Claims Act) deemed facility for medical malpractice.

Affordable Care Act

The Lawton Community Health Center (LCHC) was awarded a grant from the Health and Human Services department to help educate the uninsured about the new health coverage options made available by the Affordable Care Act (ACA), as well as help them enroll. Learn all you need to know about the Affordable Care Act and the Marketplace»